Barts-MS rose-tinted-odometer ★
When last have you weighed yourself and calculated your BMI (body mass index)?
BMI = body mass (kg) / the square of the body height (m) [kg/m2]; to save you time and effort you can simply use the NHS BMI calculator, which takes imperial measurements as well.
I am not sure if you are aware that childhood and adolescent obesity is an important risk factor for developing MS. We estimate that smoking and obesity could account for 1 in 5 new cases of MS. Obesity is a complex disorder that tends to run in families. The familial link is not only due to the effect of genes but cultural and social factors. If you are obese, or very obese, you need to do something at a personal level that may inform what the next generation does about it; good habits are infectious.
I have little doubt that obesity impacts on MS outcomes. Obesity affects mobility and is associated with deconditioning and poorer outcomes. I recall a patient of mine with primary progressive MS losing over 30 kg in weight, with his BMI dropping from over 30 to less than 24, and in parallel, his EDSS improved from 6.5 to 5.5. The latter improvement was from him getting fit from his 5-day per week exercise programme and making the effort.
As you are aware obesity is associated with a metabolic shitstorm that impacts on many disease processes. Obesity causes metabolic syndrome (hypertension, insulin resistance, glucose intolerance, diabetes and dyslipidaemia) and a systemic inflammatory syndrome that may worsen MS. Therefore, there is a good reason why, if you are obese you should consider doing something about it. This is easier said than done. To start I would recommend you read “Why we get fat and what to do about it”, by Gary Taubes or you can watch his lecture on YouTube. Understanding the metabolic issues that underlie obesity will allow you to understand what to do about it. The latest science behind obesity is not rocket science.
Why this post just before Christmas? Christmas is a time of excess and maybe this post will make you mindful of what and how you eat. I was horrified when I read the forecast in this week’s New England Journal of Medicine that by 2030 1 in 2 US adults will be obese. The conclusion of the paper says it all.
“We project that given current trends, nearly 1 in 2 U.S. adults will have obesity (BMI>30) by 2030, and the prevalence will be higher than 50% in 29 states and not below 35% in any state — a level currently considered high. Furthermore, our projections show that severe obesity (BMI>35) will affect nearly 1 in 4 adults by 2030 and become the most common BMI category among women, black non-Hispanic adults, and low-income adults.”
I suspect the UK is not far behind the US. What we need to realise that underlying this epidemic in obesity is an MS epidemic. Don’t you think we should do something about it?
Ward et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med, 381 (25), 2440-2450 2019 Dec 19.
Background: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.
Methods: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.
Results: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).
Conclusions: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).